Operate, actions

Actions

Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.

Eligibility engine
1,339
Eligibility conflict resolved
1,339 proposed
Claims processor
9,112
Orphan claim re-pointed
9,112 executed
Outreach
7,319
Outreach address corrected, Outreach suppressed pending steward
2,993 proposed4,326 held
Next-best-action
3,896
Care coordination outreach, New member onboarding
3,896 proposed
Member services
4,974
Duplicate member record retired
4,974 executed

Actions

26,640 derived from the last resolution run

TypeAllEligibility conflict resolved1,339Orphan claim re-pointed9,112Outreach address corrected2,993Outreach suppressed pending steward4,326Care coordination outreach1,815New member onboarding2,081Duplicate member record retired4,974
StatusAllProposed8,228Executed14,086Held4,326Released0
ActionTypeTitleDetailLinked toStatusExecuted
ACT-002712
Orphan claim re-pointed
Claims processor
CLM-424166 → UHC-44839-36 (Mark Reyes)
Member id
UHC-44839-36
Confidence
1
Method
probabilistic
MBR-011567CLM-424166
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002713
Orphan claim re-pointed
Claims processor
CLM-426208 → UHC-77199-91 (Kyle Lawrence)
Member id
UHC-77199-91
Confidence
1
Method
probabilistic
MBR-006035CLM-426208
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002714
Orphan claim re-pointed
Claims processor
CLM-428450 → UHC-20288-13 (Heather Jackson)
Member id
UHC-20288-13
Confidence
0.97
Method
deterministic
MBR-018019CLM-428450
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002715
Orphan claim re-pointed
Claims processor
CLM-402226 → UHC-74636-77 (Alice Singh)
Member id
UHC-74636-77
Confidence
0.93
Method
probabilistic
MBR-008825CLM-402226
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002716
Orphan claim re-pointed
Claims processor
CLM-418765 → UHC-54913-54 (Tyler Vargas)
Member id
UHC-54913-54
Confidence
0.94
Method
probabilistic
MBR-013478CLM-418765
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002717
Orphan claim re-pointed
Claims processor
CLM-400599 → UHC-95609-38 (Kayla McDonald)
Member id
UHC-95609-38
Confidence
1
Method
probabilistic
MBR-037828CLM-400599
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002718
Orphan claim re-pointed
Claims processor
CLM-432085 → UHC-43805-72 (William Wells)
Member id
UHC-43805-72
Confidence
0.99
Method
probabilistic
MBR-015157CLM-432085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002719
Orphan claim re-pointed
Claims processor
CLM-429564 → UHC-71882-37 (Robert Robinson)
Member id
UHC-71882-37
Confidence
1
Method
probabilistic
MBR-000165CLM-429564
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002720
Orphan claim re-pointed
Claims processor
CLM-432075 → UHC-67683-28 (Emily Shaw)
Member id
UHC-67683-28
Confidence
1
Method
probabilistic
MBR-001486CLM-432075
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002721
Orphan claim re-pointed
Claims processor
CLM-426389 → UHC-69005-94 (Debra Sullivan)
Member id
UHC-69005-94
Confidence
1
Method
probabilistic
MBR-001663CLM-426389
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002722
Orphan claim re-pointed
Claims processor
CLM-427580 → UHC-53260-05 (Ralph Peterson)
Member id
UHC-53260-05
Confidence
1
Method
probabilistic
MBR-006611CLM-427580
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002723
Orphan claim re-pointed
Claims processor
CLM-410965 → UHC-16525-11 (Angela Vargas)
Member id
UHC-16525-11
Confidence
1
Method
probabilistic
MBR-004078CLM-410965
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002724
Orphan claim re-pointed
Claims processor
CLM-417073 → UHC-24476-29 (Hannah Williams)
Member id
UHC-24476-29
Confidence
1
Method
probabilistic
MBR-000004CLM-417073
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002725
Orphan claim re-pointed
Claims processor
CLM-427757 → UHC-02487-95 (Dennis Kelly)
Member id
UHC-02487-95
Confidence
1
Method
probabilistic
MBR-016016CLM-427757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002726
Orphan claim re-pointed
Claims processor
CLM-400506 → UHC-03740-18 (William Ferguson)
Member id
UHC-03740-18
Confidence
1
Method
probabilistic
MBR-009687CLM-400506
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002727
Orphan claim re-pointed
Claims processor
CLM-406397 → UHC-04319-84 (Barbara Simpson)
Member id
UHC-04319-84
Confidence
1
Method
probabilistic
MBR-011042CLM-406397
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002728
Orphan claim re-pointed
Claims processor
CLM-424635 → UHC-40221-33 (Dylan Welch)
Member id
UHC-40221-33
Confidence
1
Method
probabilistic
MBR-025816CLM-424635
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002729
Orphan claim re-pointed
Claims processor
CLM-413132 → UHC-47460-74 (Steven Kelly)
Member id
UHC-47460-74
Confidence
0.97
Method
deterministic
MBR-019109CLM-413132
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002730
Orphan claim re-pointed
Claims processor
CLM-432080 → UHC-79111-93 (Scott Campbell)
Member id
UHC-79111-93
Confidence
1
Method
probabilistic
MBR-028283CLM-432080
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002731
Orphan claim re-pointed
Claims processor
CLM-416782 → UHC-87829-83 (Karen Meyer)
Member id
UHC-87829-83
Confidence
1
Method
probabilistic
MBR-007387CLM-416782
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002732
Orphan claim re-pointed
Claims processor
CLM-412804 → UHC-32846-70 (Jesse Stevens)
Member id
UHC-32846-70
Confidence
0.97
Method
deterministic
MBR-041042CLM-412804
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002733
Orphan claim re-pointed
Claims processor
CLM-423589 → UHC-44191-84 (Kevin Singh)
Member id
UHC-44191-84
Confidence
0.97
Method
deterministic
MBR-004924CLM-423589
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002734
Orphan claim re-pointed
Claims processor
CLM-417819 → UHC-14494-39 (Sharon Cox)
Member id
UHC-14494-39
Confidence
0.97
Method
deterministic
MBR-028773CLM-417819
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002735
Orphan claim re-pointed
Claims processor
CLM-404601 → UHC-72403-52 (Russell Elliott)
Member id
UHC-72403-52
Confidence
1
Method
probabilistic
MBR-019098CLM-404601
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002736
Orphan claim re-pointed
Claims processor
CLM-409624 → UHC-22515-20 (Bruce Adams)
Member id
UHC-22515-20
Confidence
0.97
Method
deterministic
MBR-034654CLM-409624
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002737
Orphan claim re-pointed
Claims processor
CLM-407609 → UHC-88336-76 (Richard Washington)
Member id
UHC-88336-76
Confidence
1
Method
probabilistic
MBR-034353CLM-407609
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002738
Orphan claim re-pointed
Claims processor
CLM-419247 → UHC-20089-46 (Sophia Bell)
Member id
UHC-20089-46
Confidence
0.93
Method
probabilistic
MBR-027431CLM-419247
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002739
Orphan claim re-pointed
Claims processor
CLM-417820 → UHC-02024-63 (Rachel Knight)
Member id
UHC-02024-63
Confidence
0.97
Method
deterministic
MBR-032025CLM-417820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002740
Orphan claim re-pointed
Claims processor
CLM-411257 → UHC-34912-78 (Jessica Vargas)
Member id
UHC-34912-78
Confidence
1
Method
probabilistic
MBR-000636CLM-411257
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002741
Orphan claim re-pointed
Claims processor
CLM-418147 → UHC-72529-98 (Vincent Thomas)
Member id
UHC-72529-98
Confidence
1
Method
probabilistic
MBR-008558CLM-418147
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002742
Orphan claim re-pointed
Claims processor
CLM-412184 → UHC-00823-45 (Kathryn Hart)
Member id
UHC-00823-45
Confidence
1
Method
probabilistic
MBR-010033CLM-412184
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002743
Orphan claim re-pointed
Claims processor
CLM-417916 → UHC-78083-57 (Judith West)
Member id
UHC-78083-57
Confidence
0.86
Method
probabilistic
MBR-012031CLM-417916
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002744
Orphan claim re-pointed
Claims processor
CLM-405477 → UHC-12782-69 (Watson Steven)
Member id
UHC-12782-69
Confidence
1
Method
probabilistic
MBR-020361CLM-405477
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002745
Orphan claim re-pointed
Claims processor
CLM-400217 → UHC-17817-28 (Harold Pena)
Member id
UHC-17817-28
Confidence
1
Method
probabilistic
MBR-011646CLM-400217
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002746
Orphan claim re-pointed
Claims processor
CLM-410227 → UHC-56472-37 (Lori Coooper)
Member id
UHC-56472-37
Confidence
0.98
Method
probabilistic
MBR-027834CLM-410227
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002747
Orphan claim re-pointed
Claims processor
CLM-406085 → UHC-37995-02 (Santiago Phillips)
Member id
UHC-37995-02
Confidence
1
Method
probabilistic
MBR-031544CLM-406085
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002748
Orphan claim re-pointed
Claims processor
CLM-409191 → UHC-85772-60 (Jerry Rojas)
Member id
UHC-85772-60
Confidence
1
Method
probabilistic
MBR-009572CLM-409191
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002749
Orphan claim re-pointed
Claims processor
CLM-418685 → UHC-97712-18 (Noah Franklin)
Member id
UHC-97712-18
Confidence
1
Method
probabilistic
MBR-001244CLM-418685
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002750
Orphan claim re-pointed
Claims processor
CLM-428646 → UHC-43545-99 (Madison Johnston)
Member id
UHC-43545-99
Confidence
1.00
Method
probabilistic
MBR-028144CLM-428646
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002751
Orphan claim re-pointed
Claims processor
CLM-405306 → UHC-89211-17 (Dnise Sandoval)
Member id
UHC-89211-17
Confidence
0.97
Method
deterministic
MBR-018465CLM-405306
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002752
Orphan claim re-pointed
Claims processor
CLM-417263 → UHC-30181-71 (Adam Dunn)
Member id
UHC-30181-71
Confidence
1
Method
probabilistic
MBR-018956CLM-417263
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002753
Orphan claim re-pointed
Claims processor
CLM-413608 → UHC-19719-99 (Lucia Castillo)
Member id
UHC-19719-99
Confidence
0.97
Method
deterministic
MBR-009790CLM-413608
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002754
Orphan claim re-pointed
Claims processor
CLM-432537 → UHC-00910-81 (Doris McDonald)
Member id
UHC-00910-81
Confidence
1
Method
probabilistic
MBR-002629CLM-432537
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002755
Orphan claim re-pointed
Claims processor
CLM-420757 → UHC-29811-40 (Ken Duncan)
Member id
UHC-29811-40
Confidence
0.94
Method
probabilistic
MBR-017051CLM-420757
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002756
Orphan claim re-pointed
Claims processor
CLM-401682 → UHC-35149-69 (Abigail Coleman)
Member id
UHC-35149-69
Confidence
1
Method
probabilistic
MBR-003873CLM-401682
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002757
Orphan claim re-pointed
Claims processor
CLM-414970 → UHC-58152-86 (Barbara Palmer)
Member id
UHC-58152-86
Confidence
0.97
Method
deterministic
MBR-024424CLM-414970
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002758
Orphan claim re-pointed
Claims processor
CLM-400353 → UHC-40216-61 (Elizabeth Elizabeth)
Member id
UHC-40216-61
Confidence
0.98
Method
probabilistic
MBR-034293CLM-400353
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002759
Orphan claim re-pointed
Claims processor
CLM-419161 → UHC-32991-98 (Benjamin Gomez)
Member id
UHC-32991-98
Confidence
0.99
Method
probabilistic
MBR-026623CLM-419161
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002760
Orphan claim re-pointed
Claims processor
CLM-425440 → UHC-25028-43 (Donald Lene)
Member id
UHC-25028-43
Confidence
0.97
Method
probabilistic
MBR-033980CLM-425440
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002761
Orphan claim re-pointed
Claims processor
CLM-429052 → UHC-36756-03 (William Hall)
Member id
UHC-36756-03
Confidence
1
Method
probabilistic
MBR-007217CLM-429052
Executed
resolution_agent
2026-10-22 12:47:23
26,640 rows, page 193 of 533PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 1
    Eligibility conflict resolved
    The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
  2. 2
    Orphan claim re-pointed
    A claim arrived without a member ID. Resolution attached it to an identity that has one, so the claims processor can now pay it against the right member.
  3. 3
    Outreach address corrected
    The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
  4. 4
    Outreach suppressed pending steward
    The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
  5. 5
    Care coordination outreach
    Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
  6. 6
    New member onboarding
    A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
  7. 7
    Duplicate member record retired
    Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.